Provider Demographics
NPI:1215152582
Name:BINGHAM, LINDA HARDIN (MSW)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:HARDIN
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:HARDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 562850
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96156-2850
Mailing Address - Country:US
Mailing Address - Phone:530-573-3251
Mailing Address - Fax:
Practice Address - Street 1:1120 3RD ST
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-3451
Practice Address - Country:US
Practice Address - Phone:530-573-3251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 154301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical